{
"Npi": {
"NPI": "1891184859",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PRESCRIPTION PLACE OF NICEVILLE LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1140 JOHN SIMS PKWY E",
"SecondLineMailingAddress": "SUITE 6",
"MailingAddressCityName": "NICEVILLE",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32578-2204",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "850-892-6898",
"MailingAddressFaxNumber": "850-389-8182",
"FirstLinePracticeLocationAddress": "1140 JOHN SIMS PKWY E",
"SecondLinePracticeLocationAddress": "SUITE 6",
"PracticeLocationAddressCityName": "NICEVILLE",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "32578-2204",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "850-389-8182",
"PracticeLocationAddressFaxNumber": "850-389-8185",
"EnumerationDate": "01/14/2015",
"LastUpdateDate": "02/05/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ABBOTT",
"AuthorizedOfficialFirstName": "SHANE",
"AuthorizedOfficialMiddleName": "G",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "850-389-8182",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "PH28801",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}